Provider Demographics
NPI:1457574386
Name:HAMILTON, KIRK (PA,C)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4205
Mailing Address - Country:US
Mailing Address - Phone:916-716-2295
Mailing Address - Fax:916-489-1710
Practice Address - Street 1:3301 ALTA ARDEN EXPY
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-489-4400
Practice Address - Fax:916-489-1710
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11343OtherLICENSE #
CAMH1206057OtherDEA NUMBER